Exercise Research Articles

Prediction of risk for isolated incomplete lateral meniscal injury using a dynamic nomogram based on MRI-derived anatomic radiomics and physical activity: a proof-of-concept study in 3PM-guided management

Prediction of risk for isolated incomplete lateral meniscal injury using a dynamic nomogram based on MRI-derived anatomic radiomics and physical activity: a proof-of-concept study in 3PM-guided management

Exploring the Feasibility of a 5-Week mHealth Intervention to Enhance Physical Activity and an Active, Healthy Lifestyle in Community-Dwelling Older Adults: Mixed Methods Study.

Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA). The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot. Our study used a mixed methods approach to evaluate the MIA app's acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based. The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6%. Analysis showed general satisfaction with the app's workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants. The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults. ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515.

Exploring the Psychological and Physiological Insights Through Digital Phenotyping by Analyzing the Discrepancies Between Subjective Insomnia Severity and Activity-Based Objective Sleep Measures: Observational Cohort Study.

Insomnia is a prevalent sleep disorder affecting millions worldwide, with significant impacts on daily functioning and quality of life. While traditionally assessed through subjective measures such as the Insomnia Severity Index (ISI), the advent of wearable technology has enabled continuous, objective sleep monitoring in natural environments. However, the relationship between subjective insomnia severity and objective sleep parameters remains unclear. This study aims to (1) explore the relationship between subjective insomnia severity, as measured by ISI scores, and activity-based objective sleep parameters obtained through wearable devices; (2) determine whether subjective perceptions of insomnia align with objective measures of sleep; and (3) identify key psychological and physiological factors contributing to the severity of subjective insomnia complaints. A total of 250 participants, including both individuals with and without insomnia aged 19-70 years, were recruited from March 2023 to November 2023. Participants were grouped based on ISI scores: no insomnia, mild, moderate, and severe insomnia. Data collection involved subjective assessments through self-reported questionnaires and objective measurements using wearable devices (Fitbit Inspire 3) that monitored sleep parameters, physical activity, and heart rate. The participants also used a smartphone app for ecological momentary assessment, recording daily alcohol consumption, caffeine intake, exercise, and stress. Statistical analyses were used to compare groups on subjective and objective measures. Results indicated no significant differences in general sleep structure (eg, total sleep time, rapid eye movement sleep time, and light sleep time) among the insomnia groups (mild, moderate, and severe) as classified by ISI scores (all P>.05). Interestingly, the no insomnia group had longer total awake times and lower sleep quality compared with the insomnia groups. Among the insomnia groups, no significant differences were observed regarding sleep structure (all P>.05), suggesting similar sleep patterns regardless of subjective insomnia severity. There were significant differences among the insomnia groups in stress levels, dysfunctional beliefs about sleep, and symptoms of restless leg syndrome (all P≤.001), with higher severity associated with higher scores in these factors. Contrary to expectations, no significant differences were observed in caffeine intake (P=.42) and alcohol consumption (P=.07) between the groups. The findings demonstrate a discrepancy between subjective perceptions of insomnia severity and activity-based objective sleep parameters, suggesting that factors beyond sleep duration and quality may contribute to subjective sleep complaints. Psychological factors, such as stress, dysfunctional sleep beliefs, and symptoms of restless legs syndrome, appear to play significant roles in the perception of insomnia severity. These results highlight the importance of considering both subjective and objective assessments in the evaluation and treatment of insomnia and suggest potential avenues for personalized treatment strategies that address both psychological and physiological aspects of sleep disturbances. Clinical Research Information Service KCT0009175; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26133.

Dinosaurs, Mushrooms, and Geometric Forms - Conversations with Young Children About Natural Science and Mathematics

Abstract In this case study, we explore how early childhood education and care (ECEC) teachers can foster children’s participation in conversations about natural science and mathematics and what factors influence it. Data consisted of 29 conversations between ECEC teachers and children. The results showed that eight of the conversations were open dialogues in which the teachers and children participated equally. In 19 of the conversations, the ECEC teachers led the conversation, and the children, to various degrees, were active and engaged participants. Two conversations were led by the children. The results showed that the children participated more actively in conversations about natural science than mathematics, and that multisensory artifacts and physical activities enhanced their participation in the conversations. The study suggests that ECEC settings should provide more opportunities for multisensory experiences and physical activities, and that teachers need more guidance on how to explain concepts and phenomena, within natural science and mathematics, to children of different ages.

P-34 XX MALE SYNDROME DIAGNOSED AT AGE 52

Abstract Introduction XX male syndrome (de la Chapelle syndrome) is a rare disorder of sex development linked to a 46,XX karyotype. Depending on the presence of the SRY gene, two variants of this disease are distinguished: SRY-positive and SRY-negative ones. The SRY (sex-determining region Y) gene is involved in the differentiation of Sertoli cells and development of the tests. Typically, de la Chapelle syndrome is diagnosed in childhood or adolescence. We present a case where XX male syndrome was diagnosed at age 52. Clinical Case A 52-year-old man came to our clinic complaining of excess weight, decreased libido, and fatigue with little physical activity. Physical examination discovered full masculinization, microorchidism, gynecomastia, obesity. At the time of his visit, he was undergoing chemotherapy for β-cell lymphoma. It is known that due to severe pain in the spine, he had been injecting himself with dexamethasone every day for six months, which led to secondary adrenal insufficiency. When he came, we stopped dexamethasone and initiated hydrocortisone. We reduced the dosage until it was completely discontinued over 4 months. The function of the adrenal glands was completely restored, which was shown by laboratory tests. On the first visit patient said that over the past 9-10 years he had been periodically receiving testosterone therapy due to low testosterone level. The decrease in testosterone was explained by obesity. About 10 years ago, investigation was performed due to infertility. Investigation showed a low testosterone level, a high FSH and LH level, azoospermia, a small testicular volume in the ultrasound were detected. Hypergonadotropic hypogonadism was diagnosed. Karyotyping analysis revealed a chromosomal complement of 46,XX. Molecular genetic testing confirmed the SRY-positive variant of de la Chapelle syndrome. Thus, we understand the reason for patient's low testosterone, and replacement therapy with testosterone was prescribed. And we recommended assisted reproductive technologies using donor sperm. Conclusion It is important to remember that in men of any age with hypogonadism and infertility, chromosomal abnormalities must be excluded (and not only in children and adolescents).Figure 1:Karyogram of the patient, 46,XX

Accelerometer-measured physical activity timing with incident dementia.

Moderate to vigorous physical activity (MVPA) is linked to lower dementia risk, though the optimal timing remains unclear. Using accelerometer-measured MVPA data from 90,329 dementia-free UK Biobank participants with at least 2 years of follow-up, we assessed associations between MVPA patterns (morning, afternoon, evening, mixed, inactive) and dementia risk via multivariable-adjusted Cox proportional hazards models. Compared to the inactive group, participants with a tendency of morning MVPA had a lower risk of all-cause dementia (hazard ratio [HR]: 0.60, 95% confidence interval [CI]: 0.40-0.90) and Alzheimer's disease (AD) risk (HR: 0.44, 95% CI: 0.22-0.86). No association of the other time point with all-cause dementia was observed. Additionally, the incidence of vascular dementia (VD) did not exhibit a significant relationship among all timing groups. Morning MVPA was associated with a lower risk of all-cause dementia and AD, while MVPA at any time point showed no association with VD. Few studies have examined accelerometer-measured moderate to vigorous physical activity (MVPA) timing with incident dementia. Participants with a tendency of morning MVPA had a lower risk of all-cause dementia and Alzheimer's disease. No significant association was found between all MVPA timing and vascular dementia (VD) risk. Findings suggest timing-specific physical activityinterventions for dementia prevention.

P-28 A CASE OF MODY TYPE 9 WITH C.89T>C MUTATION IN PAX4 GENE

Abstract Introduction Maturity-onset diabetes (MODY) is a rare type of diabetes mellitus (DM) with autosomal dominant inheritance that occurs at a young age, constituting 1-2% of all DM cases. Most MODY cases are misdiagnosed as type 1 or type 2 DM. MODY9 is a rare type caused by a mutation in the Paired box gene 4 (PAX4). We aimed to present a case that had been followed for eight years, initially diagnosed as type 1 DM, but later diagnosed with MODY type 9 after a PAX4 gene mutation was detected as a result of genetic analysis. Clinical Case A 23-year-old male patient had been followed up for eight years with a diagnosis of type 1 DM. In the evaluation, his body mass index was normal, fasting glucose level was 143 mg/dl, HbA1c was 9.5%, C peptide level was 607 pmol/L (370-1470 pmol/L), low-density lipoprotein was 112 mg/dl, and triglyceride was 60 mg/dl. He did not show signs of diabetic neuropathy or retinopathy and had no history of hospitalization due to diabetic ketoacidosis. His father also had DM. Because the patient was diagnosed at a young age, type 1 DM was accepted without checking insulin autoantibodies at the time of diagnosis, and intensive insulin therapy was started. Due to the patient's age, normal body mass index, normal C peptide level, family history and genetic evaluation was requested for monogenic diabetes diseases. As a result of the analysis performed in the patient's genetic laboratory, the C.89T>C missense variant in the PAX4 gene was detected. As a result of clinical findings and gene analysis, the patient was diagnosed with MODY type 9. Conclusion PAX4-MODY typically presents between ages 6 to 44 and is more common in men. The severity of diabetes may vary, with some patients experiencing diabetic ketoacidosis (DKA), impaired glucose tolerance, and potential complications such as renal or retinal issues, or end-stage renal failure. Treatment for MODY9 primarily involves a diabetic diet, physical activity, insulin therapy, and possibly oral hypoglycemic agents, tailored to the individual's disease progression.

Can exercise reduce fatigue in people living with kidney disease?

In people living with kidney disease (KD) Fatigue is a whole-body tiredness that is not related to activity or exertion. Often self-reported, fatigue is a common and highly burdensome symptom, yet poorly defined and understood. While its mechanisms are complex, many fatigue-related factors may be altered by exercise and physical activity intervention. Thus, this review aims to review the latest research on exercise in reducing fatigue in people living with KD. The benefits of exercise in KD are well known, yet recent data from clinical trials on fatigue are scarce. Favourable effects on fatigue were found through a myriad of physical activity and exercise-based interventions, including using exercise-based video games, exercise during dialysis, nurse-led exercise programs, and home-based exercise delivered by a novel digital health intervention. Yet, whilst the handful of recent trials show positive efficacy on fatigue across the spectrum of KD, contemporary exercise-based research was impacted critically by COVID-19, and the field is limited by underpowered trials and heterogeneity of assessment tools. Fatigue remains, at best, a secondary outcome measure in trials despite it being the most commonly reported symptom in KD. Given its importance to the people it impacts most, better quality evidence is needed to fully understand and optimize the impact of exercise in this group.

Optimal calorie restriction threshold: effect of FATmax exercise combined with different proportions of calorie restriction on hypercholesterolemia

Background/ObjectivesTo evaluate the impact of maximal fat oxidation intensity exercise combined with calorie restriction intervention on lipid-related parameters in a hypercholesterolemic population, and to determine if an optimal range of calorie restriction exists for effectively enhancing blood lipid profiles.MethodsA 4-week intervention study combined exercise and calorie restriction for 64 patients aged 18–60 with secondary hypercholesterolemia. Ultimately, 43 participants completed the study. The dietary intervention adhered to the principles of a balanced diet, with meal plans designed to provide three meals per day for the duration of the study. Each subject’s daily calorie intake was set to match their individual resting energy expenditure (REE) plus varying proportions of physical activity (PA) calories. Participants were divided into four groups based on these proportions: REE only, REE + PA33%, REE + PA67%, and REE + PA100%. FATmax exercises were conducted 5 times per week, lasting 1 h each.Results1) Compared with baseline, subjects’ body weight, fat mass and body fat rate decreased significantly; fat-free mass also decreased significantly in the REE, REE + PA33%, and REE + PA67% groups. 2) Subjects’ serum TC decreased significantly; serum LDL-C and ApoB decreased significantly in the REE, REE + PA33%, and REE + PA67% groups; there were no significant changes in serum HDL-C and ApoA1. 3) Serum PCSK9 was significantly decreased in the REE and the REE + PA 67% groups; serum LDLR was significantly decreased in all groups of subjects. 4) Between the groups, the rate of change in serum LDL-C was significantly different.ConclusionFATmax exercise combined with proper proportions of calorie restriction can significantly decrease serum cholesterol levels and fat mass in hypercholesterolemic patients. Nevertheless, it is misleading to assume that a drastic reduction in calorie intake invariably results in superior outcomes. Optimal cost-effectiveness may be achieved within a calorie restriction range of REE + PA33-67%.

Internet-Based Dementia Prevention Intervention (DementiaRisk): Protocol for a Randomized Controlled Trial and Knowledge Translation.

Research has shown that engaging in a range of healthy lifestyles or behavioral factors can help reduce the risk of developing dementia. Improved knowledge of modifiable risk factors for dementia may help engage people to reduce their risk, with beneficial impacts on individual and public health. Moreover, many guidelines emphasize the importance of providing education and web-based resources for dementia prevention. Internet-based interventions may be effective, but few have been studied rigorously or widely disseminated. We created DementiaRisk, an award-winning, web- and email-based education platform for the public focused on modifiable risk factors, featuring multimedia e-learning and email "microlearning" content, to help raise awareness and improve knowledge of actions to reduce dementia risk. This protocol describes a randomized controlled trial to (1) evaluate whether exposure to DementiaRisk changes knowledge of dementia risk factors, intention to engage in risk reduction activities, and health behaviors related to dementia risk reduction and to (2) explore qualitative aspects including participants' engagement and satisfaction with the intervention and barriers and facilitators to use. Using a sequential explanatory mixed methods design, this study conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. In total, 485 participants will be recruited on the web and randomly assigned to 2 groups: one accessing DementiaRisk and the other receiving alternative e-learning on mild cognitive impairment. Assessments will be delivered on the web at baseline (T1), at 4 weeks (T2), and at 2 months after the intervention (T3). Knowledge will be assessed using items from the Dementia Knowledge Assessment Scale, intentions to engage in risk reduction activities will be assessed using items in line with current evidence, and health behaviors related to dementia risk reduction will be assessed using items from the Godin-Shephard Leisure Time Physical Activity Questionnaire along with additional questions related to a range of health status domains. Outcomes and feasibility will be assessed using the Information Assessment Method for patients and consumers. A linear mixed effects model will be used to examine the relationship between each outcome score by group and time point. This study was approved by the Hamilton Integrated Research Ethics Board on August 24, 2022 (project ID 14886) and received funding in February 2023. Recruitment took place from March 28, 2023, to April 28, 2023, with the final participants completing the intervention by August 18, 2023. Analyses and interpretation of data are ongoing. DementiaRisk is a readily scalable, technology-enhanced solution for dementia prevention education. It has been designed using evidence-based principles of multimedia learning. It has the potential to scale and spread widely using the open internet, so it may be able to reach a wider audience than traditional in-person educational interventions. ClinicalTrials.gov NCT05383118; https://clinicaltrials.gov/study/NCT05383118. DERR1-10.2196/64718.

KiKli Fit: Insights into the Development and Practice of a Physical Activity Program in Pediatric Cancer

KiKli Fit: Insights into the Development and Practice of a Physical Activity Program in Pediatric Cancer

Utilization of smartphone technology and wearable technology following TKA.

The widespread adoption of smartphones and wearable technology has introduced innovative approaches in healthcare, particularly in postoperative rehabilitation. These technologies hold significant promise for improving recovery following lower extremity arthroplasty, especially total knee arthroplasty (TKA). Despite growing interest, the evidence on their effectiveness and long-term impact remains variable. This narrative review evaluates the utilization of smartphone applications, wearable devices, and their combined use in postoperative recovery after TKA. Key studies assessing adherence, functional outcomes, patient satisfaction, and healthcare utilization were analyzed to synthesize insights into their effectiveness compared to traditional rehabilitation approaches. Smartphone applications have demonstrated improvements in adherence to rehabilitation plans, pain management, and functional outcomes. For instance, interventions using text-based prompts or interactive platforms enhanced physical activity, reduced narcotic use, and improved patient-reported outcomes such as PROM adherence and range of motion (ROM). Similarly, wearable devices provided accurate feedback on activity levels and step counts, promoting early mobility and strength recovery. Combined approaches leveraging both technologies further enhanced adherence, functional recovery, and patient engagement while reducing healthcare utilization. The integration of smartphone and wearable technologies in TKA rehabilitation shows potential for improving recovery outcomes. While findings generally indicate noninferiority or superiority to conventional methods, limitations exist in standardization, data accuracy, and long-term benefits. Future research should focus on refining these technologies, establishing standardized guidelines, and evaluating their cost-effectiveness in diverse populations. Smartphone and wearable technologies represent safe and effective tools for enhancing postoperative outcomes in TKA patients. Their integration into clinical practice could optimize rehabilitation protocols, improve patient engagement, and potentially reduce healthcare costs.

RADAR-AD: assessment of multiple remote monitoring technologies for early detection of Alzheimer’s disease

BackgroundAlzheimer’s disease (AD) is a progressive neurodegenerative disorder affecting millions worldwide, leading to cognitive and functional decline. Early detection and intervention are crucial for enhancing the quality of life of patients and their families. Remote Monitoring Technologies (RMTs) offer a promising solution for early detection by tracking changes in behavioral and cognitive functions, such as memory, language, and problem-solving skills. Timely detection of these symptoms can facilitate early intervention, potentially slowing disease progression and enabling appropriate treatment and care.MethodsThe RADAR-AD study was designed to evaluate the accuracy and validity of multiple RMTs in detecting functional decline across various stages of AD in a real-world setting, compared to standard clinical rating scales. Our approach involved a univariate analysis using Analysis of Covariance (ANCOVA) to analyze individual features of six RMTs while adjusting for variables such as age, sex, years of education, clinical site, BMI and season. Additionally, we employed four machine learning classifiers – Logistic Regression, Decision Tree, Random Forest, and XGBoost – using a nested cross-validation approach to assess the discriminatory capabilities of the RMTs.ResultsThe ANCOVA results indicated significant differences between healthy and AD subjects regarding reduced physical activity, less REM sleep, altered gait patterns, and decreased cognitive functioning. The machine-learning-based analysis demonstrated that RMT-based models could identify subjects in the prodromal stage with an Area Under the ROC Curve of 73.0 %. In addition, our findings show that the Amsterdam iADL questionnaire has high discriminatory abilities.ConclusionsRMTs show promise in AD detection already in the prodromal stage. Using them could allow for earlier detection and intervention, thereby improving patients’ quality of life. Furthermore, the Amsterdam iADL questionnaire holds high potential when employed remotely.

Sex differences in the metabolism of glucose and fatty acids by adipose tissue and skeletal muscle in humans.

Adult males and females have markedly different body composition, energy expenditure, and have different degrees of risk for metabolic diseases. A major aspect of metabolic regulation involves the appropriate storage and disposal of glucose and fatty acids. The use of sophisticated calorimetry, tracer, and imaging techniques have provided insight into the complex metabolism of these substrates showing that the regulation of these processes varies tremendously throughout the day, from the overnight fasting condition to meal ingestion, to the effects of physical activity. The sexual dimorphism in substrate metabolism is most readily observed in how fatty acids are stored and mobilized. The objective of this review is to provide a comprehensive and critical summary of the reported sex-differences in the mobilization, oxidation and storage of fat and carbohydrate in adipose tissue and skeletal muscle. We will describe how adipose tissue lipolysis differs between sexes, and how this varies between fed, fasted and exercise conditions. We will also review what is known about endogenous and exogenous fatty acid storage in adipose tissue and muscle, as well as how oxidation compares between men and women in response to exercise. What has been learned about the cellular level regulation of these processes will be described. Although glucose metabolism exhibits fewer differences between men and women, we will also review the existing knowledge on this topic.

Evaluating the impact of an after-school program on overhand throwing and perceived motor competence among students from low socio-economic backgrounds in the U.S.

The study examined the effect of a 5-week Comprehensive School Physical Activity Program (CSPAP) on overhand throw skills and perceived motor competence in students from low socio-economic backgrounds. Participants were children recruited from a Title 1 school in the Southwest U.S. Students were assigned to either CSPAP condition (n = 60, 26 boys, 34 girls; Mgrade = 4.27, SD = .43) or a control condition (n = 20, 7 boys, 13 girls; Mgrade = 4.00, SD = .35). Overhand throwing and perceived motor competence were assessed at baseline and post-intervention using the Test of Gross Motor Development—2nd Edition and Perceived Motor Competence for Children (PMC-C). The Analysis of Covariance test showed that students who participated in the CSPAP performed statistically significant improvements in the overhand throw compared to control students in the post-test p < .001, with a moderate effect size. However, there was no significant difference in the PMC-C score after the 5-week intervention between the CSPAP students and control students. CSPAP can improve overhand throwing in students from low-income families, but new strategies are needed to enhance perceived motor competence in after-school contexts.

Physical Activity Behavior in Swiss Secondary School Students: A Segmented Analysis

Physical Activity Behavior in Swiss Secondary School Students: A Segmented Analysis

KiKli Fit: Investigating the Implementation of a Physical Activity Program in Pediatric Cancer

KiKli Fit: Investigating the Implementation of a Physical Activity Program in Pediatric Cancer

O-16 A CASE OF VITAMIN D-DEPENDENT RICKETS DIAGNOSED IN ADULTHOOD FOLLOWING PREGNANCY

Abstract Discussion Vitamin-D (Vit-D)-dependent rickets are the result of a deficiency in 1-alpha hydroxylase. It is a rare condition that is typically diagnosed in childhood. We present a case of Vit-D-dependent rickets that was detected in adulthood after pregnancy. Clinical Case A 25-year-old female patient has been sent from the neurosurgical clinic to the endocrinology department for evaluation of Vit-D deficiency, which is believed to be causing muscle weakness. She experienced chronic lower back discomfort that began two years ago. She experienced challenges when going down stairs and when bending her body forward. Rest alleviated the lower back pain, whereas physical activity exacerbated it, and it did not interfere with her sleep. The weakness in the legs was there with it. There was no previous fractures or other form of physical injury. The woman's issues became evident after her pregnancy. She consulted a physician nine months postpartum, following the birth of a robust infant. The patient's personal and family history was unremarkable. She had no smoking or drinking habits. During the physical examination, the patient stood 150cm tall and weighed 60kg. Except for left lower extremity muscle strength, which was 3-4/5 on the neurological assessment, everything else was normal. In her laboratory results; calcium 8 mg/dl (8.8-10.6), ionized calcium 3.61mg/dL (4.6-5.0), albumin 4.7 g/dl (3.5-5.2), phosphorus 2.1 mg/dl (2.5-4.5), parathormone 640 ng/L (12-88), creatinine kinase 50 U/L (0-145), alkaline phosphatase 345 U/L (33-98), 25-OH Vit-D 24.2 ug/L, leukocyte: 7100/uL, hemoglobin 11.6 gr/dl, thrombocyte 336000/uL, ALT: 6.6 U/L, osteocalsin: 65 ng/mL (11-48), 1,25-OH Vit-D level: 43.1 pg/mL (15-90). Computed CT revealed type H vertebrae in the thoracic vertebrae, with no disease found in the lumbar, cervical, pelvic, or femur. (Figure 1). Bone density (BD): L1-L4 Z score: -2.7 BMD: 0.858; Femoral neck Z score: -2.7 BMD: 0.644. The EMG results were consistent with moderate myopathy. After one year of complaints, she became wheelchair-dependent. At that point, a neurosurgical doctor prescribed Vit-D and calcium tablets. She was able to walk again in two months and referred to our clinic two years after the initial issue. Genetic testing revealed that CYP27b1>homozygous positive was compatible with Vit-D dependent Rickets Type 1. During the two-year diagnostic period, the patient's height dropped from 153 cm to 150 cm. Calcitriol 0.25 mcg was administered every other day. Her calcium level: 9.4 mg/dL and phosphorus level: 2.2 mg/dL following treatment. This type of rickets is caused by a lack of the 1-alpha hydroxylase enzyme, which is essential for Vit-D production in the kidney. Untreated patients may have muscular and bone abnormalities. It is a sickness that responds exceptionally well to treatment.Figure 1:Vertebral lateral X -ray revealed H shaped vertebrae

Estimated dietary flavonoid intake and major food contributors in the Portuguese population: results from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016).

Flavonoids are a key class of polyphenols, i.e., phytochemical compounds present in foods and beverages, which have been described as having health benefits in preventing several chronic diseases. Estimating flavonoid intake has already been conducted in several countries but has yet to be performed in Portugal. This study included 5,005 participants aged 3-84 years and aimed to estimate dietary flavonoid intake in the Portuguese population, using data from the National Food and Physical Activity Survey 2015-2016, providing information on intake, main food contributors, and the socio-demographic factors associated with the intake. Food intake data from the Survey was converted to flavonoid intake using a database built to include the most updated USDA databases on flavonoids, isoflavones and proanthocyanidins, and the Phenol-Explorer database. The rationale for combining food consumption data and different flavonoid databases using the FoodEx2 classification system was established. Linear regressions assessed the associations between socio-demographic factors and dietary flavonoid intake. The total flavonoid intake of the Portuguese population was estimated to be 107.3 mg/day. Flavanols were the most representative subclass, followed by flavonols, anthocyanidins, flavanones, flavones and isoflavones. Fruits and vegetables were the primary food contributors, providing 31.5% and 12.4% of the total flavonoid intake. Adolescents had the lowest total flavonoid intake, and older adults had the highest. This study provides information on the Portuguese population's dietary flavonoids, allowing for international comparisons. It can also streamline forthcoming investigations into the link between flavonoid consumption and its impact on health, contributing to the future establishment of dietary reference values.

Type 2 Diabetes Mellitus: New Pathogenetic Mechanisms, Treatment and the Most Important Complications

Type 2 diabetes mellitus (T2DM), a prevalent chronic disease affecting over 400 million people globally, is driven by genetic and environmental factors. The pathogenesis involves insulin resistance and β-cell dysfunction, mediated by mechanisms such as the dedifferentiation of β-cells, mitochondrial dysfunction, and oxidative stress. Treatment should be based on non-pharmacological therapy. Strategies such as increased physical activity, dietary modifications, cognitive-behavioral therapy are important in maintaining normal glycemia. Advanced therapies, including SGLT2 inhibitors and GLP-1 receptor agonists, complement these treatments and offer solid glycemic control, weight control, and reduced cardiovascular risk. Complications of T2DM, such as diabetic kidney disease, retinopathy, and neuropathy, underscore the need for early diagnosis and comprehensive management to improve patient outcomes and quality of life.